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Ren J, Xu D, Mei H, Zhong X, Yu M, Ma J, Fan C, Lv J, Xiao Y, Gao L, Xu H. Asymptomatic carotid stenosis is associated with both edge and network reconfigurations identified by single-subject cortical thickness networks. Front Aging Neurosci 2023; 14:1091829. [PMID: 36711201 PMCID: PMC9878604 DOI: 10.3389/fnagi.2022.1091829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Background and purpose Patients with asymptomatic carotid stenosis, even without stroke, are at high risk for cognitive impairment, and the neuroanatomical basis remains unclear. Using a novel edge-centric structural connectivity (eSC) analysis from individualized single-subject cortical thickness networks, we aimed to examine eSC and network measures in severe (> 70%) asymptomatic carotid stenosis (SACS). Methods Twenty-four SACS patients and 24 demographically- and comorbidities-matched controls were included, and structural MRI and multidomain cognitive data were acquired. Individual eSC was estimated via the Manhattan distances of pairwise cortical thickness histograms. Results In the eSC analysis, SACS patients showed longer interhemispheric but shorter intrahemispheric Manhattan distances seeding from left lateral temporal regions; in network analysis the SACS patients had a decreased system segregation paralleling with white matter hyperintensity burden and recall memory. Further network-based statistic analysis identified several eSC and subgraph features centred around the Perisylvian regions that predicted silent lesion load and cognitive tests. Conclusion We conclude that SACS exhibits abnormal eSC and a less-optimized trade-off between physical cost and network segregation, providing a reference and perspective for identifying high-risk individuals.
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Affiliation(s)
- Jinxia Ren
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hao Mei
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoli Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiaojiao Ma
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chenhong Fan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinfeng Lv
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yaqiong Xiao
- Center for Language and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,*Correspondence: Lei Gao, ✉
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Haibo Xu, ✉
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Bahsoun MA, Khan MU, Mitha S, Ghazvanchahi A, Khosravani H, Jabehdar Maralani P, Tardif JC, Moody AR, Tyrrell PN, Khademi A. FLAIR MRI biomarkers of the normal appearing brain matter are related to cognition. Neuroimage Clin 2022; 34:102955. [PMID: 35180579 PMCID: PMC8857609 DOI: 10.1016/j.nicl.2022.102955] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023]
Abstract
Normal appearing brain matter (NABM) biomarkers in FLAIR MRI are related to cognition. NABM texture in FLAIR MRI is correlated to mean diffusivity (MD) in dMRI. Analysis conducted on large multicentre FLAIR MRI dataset: 1400 subjects, 87 centers. NABM biomarkers vary differently across age and MoCA categories. Biomarkers showed differences in patients with AD dementia and vascular disease.
A novel biomarker panel was proposed to quantify macro and microstructural biomarkers from the normal-appearing brain matter (NABM) in multicentre fluid-attenuation inversion recovery (FLAIR) MRI. The NABM is composed of the white and gray matter regions of the brain, with the lesions and cerebrospinal fluid removed. The primary hypothesis was that NABM biomarkers from FLAIR MRI are related to cognitive outcome as determined by MoCA score. There were three groups of features designed for this task based on 1) texture: microstructural integrity (MII), macrostructural damage (MAD), microstructural damage (MID), 2) intensity: median, skewness, kurtosis and 3) volume: NABM to ICV volume ratio. Biomarkers were extracted from over 1400 imaging volumes from more than 87 centres and unadjusted ANOVA analysis revealed significant differences in means of the MII, MAD, and NABM volume biomarkers across all cognitive groups. In an adjusted ANCOVA model, a significant relationship between MoCA categories was found that was dependent on subject age for MII, MAD, intensity, kurtosis and NABM volume biomarkers. These results demonstrate that structural brain changes in the NABM are related to cognitive outcome (with different relationships depending on the age of the subjects). Therefore these biomarkers have high potential for clinical translation. As a secondary hypothesis, we investigated whether texture features from FLAIR MRI can quantify microstructural changes related to how “structured” or “damaged” the tissue is. Based on correlation analysis with diffusion weighted MRI (dMRI), it was shown that FLAIR MRI texture biomarkers (MII and MAD) had strong correlations to mean diffusivity (MD) which is related to tissue degeneration in the GM and WM regions. As FLAIR MRI is routinely collected for clinical neurological examinations, novel biomarkers from FLAIR MRI could be used to supplement current clinical biomarkers and for monitoring disease progression. Biomarkers could also be used to stratify patients into homogeneous disease subgroups for clinical trials, or to learn more about mechanistic development of dementia disease.
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Affiliation(s)
- M-A Bahsoun
- Electrical, Computer and Biomedical Engineering Dept., Ryerson University, Toronto, ON, Canada
| | - M U Khan
- Electrical, Computer and Biomedical Engineering Dept., Ryerson University, Toronto, ON, Canada
| | - S Mitha
- Electrical, Computer and Biomedical Engineering Dept., Ryerson University, Toronto, ON, Canada
| | - A Ghazvanchahi
- Electrical, Computer and Biomedical Engineering Dept., Ryerson University, Toronto, ON, Canada
| | - H Khosravani
- Hurvitz Brain Sciences Program Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - J-C Tardif
- Montreal Heart Institute, Montreal, QU, Canada; Department of Medicine, Université de Montréal, QU, Canada
| | - A R Moody
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - P N Tyrrell
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - A Khademi
- Electrical, Computer and Biomedical Engineering Dept., Ryerson University, Toronto, ON, Canada; Keenan Research Center for Biomedical Science, St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada; Institute for Biomedical Engineering, Science and Technology (iBEST), a partnership between St. Michael's Hospital and Ryerson University, Toronto, ON, Canada
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3
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Dineen RA, Blanchard CV, Pszczolkowski S, Paine S, Prasad M, Chow G, Whitehouse WP, Auer DP. Accumulation of Brain Hypointense Foci on Susceptibility-Weighted Imaging in Childhood Ataxia Telangiectasia. AJNR Am J Neuroradiol 2021; 42:1144-1150. [PMID: 33832956 DOI: 10.3174/ajnr.a7107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/24/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE SWI hypointense cerebral lesions have been reported in adults with the inherited cerebellar neurodegenerative disorder ataxia telangiectasia. This study aims to establish the prevalence, age-dependency, and spatial distribution of these lesions in children and young people with ataxia telangiectasia. MATERIALS AND METHODS Participants with classic ataxia telangiectasia and matched controls underwent SWI acquisition at 3T at 1 or 2 time points. SWI hypointense lesions were manually labeled according to the Microbleed Anatomical Rating Scale. Differences in prevalence of lesion number between groups with ataxia telangiectasia and without ataxia telangiectasia were tested with the Fisher exact test, and differences in age between participants with ataxia telangiectasia with and without lesions were tested using independent samples Mann-Whitney U test. The relationship between age and lesion number was modeled as an exponential function. RESULTS Analyzable SWI datasets from 17 participants with ataxia telangiectasia (with median age at first scan of 12.4 years; range, 4.6-20.2 years; 8 [47%] were female) and 22 matched healthy controls showed prevalence of SWI hypointense lesions in 41% of participants with ataxia telangiectasia and 0% in controls (P = .001, Fisher exact test). Lesions were exclusively supratentorial and predominantly lobar. Participants with ataxia telangiectasia with SWI hypointense lesions were older than those without (median age 5.2 years versus 9.3 years, U = 10.5, P = .014). An exponential curve described the relationship between age and lesion number (R 2 = 0.67). CONCLUSIONS SWI hypointense lesions are common in children and young people with ataxia telangiectasia, accumulating from 12 years of age onward. In contrast to cerebellar-dominant neurodegeneration in ataxia telangiectasia, SWI hypointense lesions were exclusively supratentorial. Further investigation is needed to establish the clinical relevance of these imaging-detected lesions.
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Affiliation(s)
- R A Dineen
- Radiological Sciences, Division of Clinical Neuroscience (R.A.D., C.V.B., S.Pszczolkowski, D.P.A.), University of Nottingham, Nottingham, England
- Sir Peter Mansfield Imaging Centre (R.A.D., D.P.A.), University of Nottingham, Nottingham, England
- National Institute for Health Research Nottingham Biomedical Research Centre (D.P.A.), Nottingham, England
| | - C V Blanchard
- Radiological Sciences, Division of Clinical Neuroscience (R.A.D., C.V.B., S.Pszczolkowski, D.P.A.), University of Nottingham, Nottingham, England
| | - S Pszczolkowski
- Radiological Sciences, Division of Clinical Neuroscience (R.A.D., C.V.B., S.Pszczolkowski, D.P.A.), University of Nottingham, Nottingham, England
| | - S Paine
- Department of Pathology (S. Paine), Nottingham University Hospitals National Health Service Trust, Nottingham, England
| | - M Prasad
- Nottingham Children's Hospital (M.P., G.C., W.P.W.), Nottingham University Hospitals National Health Service Trust, Nottingham, England
| | - G Chow
- Nottingham Children's Hospital (M.P., G.C., W.P.W.), Nottingham University Hospitals National Health Service Trust, Nottingham, England
| | - W P Whitehouse
- Nottingham Children's Hospital (M.P., G.C., W.P.W.), Nottingham University Hospitals National Health Service Trust, Nottingham, England
- Division of Child Health (W.P.W.), University of Nottingham, Nottingham, England
| | - D P Auer
- Radiological Sciences, Division of Clinical Neuroscience (R.A.D., C.V.B., S.Pszczolkowski, D.P.A.), University of Nottingham, Nottingham, England
- Sir Peter Mansfield Imaging Centre (R.A.D., D.P.A.), University of Nottingham, Nottingham, England
- National Institute for Health Research Nottingham Biomedical Research Centre (D.P.A.), Nottingham, England
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Gibicar A, Moody AR, Khademi A. Automated Midline Estimation for Symmetry Analysis of Cerebral Hemispheres in FLAIR MRI. Front Aging Neurosci 2021; 13:644137. [PMID: 33994994 PMCID: PMC8118126 DOI: 10.3389/fnagi.2021.644137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023] Open
Abstract
To perform brain asymmetry studies in large neuroimaging archives, reliable and automatic detection of the interhemispheric fissure (IF) is needed to first extract the cerebral hemispheres. The detection of the IF is often referred to as mid-sagittal plane estimation, as this plane separates the two cerebral hemispheres. However, traditional planar estimation techniques fail when the IF presents a curvature caused by existing pathology or a natural phenomenon known as brain torque. As a result, midline estimates can be inaccurate. In this study, a fully unsupervised midline estimation technique is proposed that is comprised of three main stages: head angle correction, control point estimation and midline generation. The control points are estimated using a combination of intensity, texture, gradient, and symmetry-based features. As shown, the proposed method automatically adapts to IF curvature, is applied on a slice-to-slice basis for more accurate results and also provides accurate delineation of the midline in the septum pellucidum, which is a source of failure for traditional approaches. The method is compared to two state-of-the-art methods for midline estimation and is validated using 75 imaging volumes (~3,000 imaging slices) acquired from 38 centers of subjects with dementia and vascular disease. The proposed method yields the lowest average error across all metrics: Hausdorff distance (HD) was 0.32 ± 0.23, mean absolute difference (MAD) was 1.10 ± 0.38 mm and volume difference was 7.52 ± 5.40 and 5.35 ± 3.97 ml, for left and right hemispheres, respectively. Using the proposed method, the midline was extracted for 5,360 volumes (~275K images) from 83 centers worldwide, acquired by GE, Siemens and Philips scanners. An asymmetry index was proposed that automatically detected outlier segmentations (which were <1% of the total dataset). Using the extracted hemispheres, hemispheric asymmetry texture biomarkers of the normal-appearing brain matter (NABM) were analyzed in a dementia cohort, and significant differences in biomarker means were found across SCI and MCI and SCI and AD.
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Affiliation(s)
- Adam Gibicar
- Electrical, Computer and Biomedical Engineering Department, Ryerson University, Toronto, ON, Canada
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - April Khademi
- Electrical, Computer and Biomedical Engineering Department, Ryerson University, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada.,Institute for Biomedical Engineering, Science and Technology, A Partnership Between St. Michael's Hospital and Ryerson University, Toronto, ON, Canada
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5
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Houghton JSM, Nickinson ATO, Bridgwood B, Nduwayo S, Pepper CJ, Rayt HS, Gray LJ, Haunton VJ, Sayers RD. Prevalence of Cognitive Impairment in Individuals with Vascular Surgical Pathology: a Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 61:664-674. [PMID: 33573912 DOI: 10.1016/j.ejvs.2020.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A significant proportion of vascular surgery patients may have undiagnosed cognitive impairment; however, its true prevalence and impact on outcomes are unknown. The aim of this review was to estimate the prevalence of cognitive impairment among individuals with clinically significant vascular surgical pathology and investigate its associations with post-operative outcomes in those undergoing vascular surgery. METHODS MEDLINE, EMBASE, EMCare, CINAHL, PsycINFO, and Scopus were searched for relevant studies. Included studies assessed cognitive function among individuals with either symptomatic vascular surgical pathology, or disease above threshold for intervention, using a validated cognitive assessment tool. The primary outcome measure was prevalence of cognitive impairment. Secondary outcomes included incidence of post-operative delirium (POD). Two reviewers independently extracted relevant study data and assessed risk of bias (ROBINS-E or RoB 2 tool). Prevalence (%) of cognitive impairment was calculated for individual studies and presented with 95% confidence intervals (CI). Prevalence data from comparable studies were pooled using the Mantel-Haenszel method (random effects model) for separate vascular disease types. Certainty of effect estimates was assessed using the GRADE criteria. RESULTS Twenty-four studies (2 564 participants) were included in the systematic review, and nine studies (1 310 participants) were included in the meta-analyses. The prevalence of cognitive impairment was 61% (95% CI 48 - 74; 391 participants; low certainty) in studies including multiple vascular surgical pathologies, 38% (95% CI 32 - 44; 278 participants; very low certainty) in carotid artery disease, and 19% (95% CI 10 - 33; 641 participants; low certainty) in those with intermittent claudication. Lower cognitive assessment scores were associated with POD (five studies; 841 participants), but data were not suitable for pooling. CONCLUSION Screening elective vascular surgery patients for cognitive impairment may be appropriate given its high prevalence, and the association of worse cognition with POD, among individuals with clinically significant vascular surgical pathology.
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Affiliation(s)
- John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK.
| | - Andrew T O Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Bernadeta Bridgwood
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sarah Nduwayo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Coral J Pepper
- Library Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet S Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
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6
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Liu L, Huang Q, Yang S, Wen Y, He W, Liu H, Meng L, Jiang H, Xia J, Liao W, Liu Y. Micro-structural white matter abnormalities and cognitive impairment in asymptomatic carotid plaque patients: A DTI study using TBSS analysis. Clin Neurol Neurosurg 2020; 197:106096. [PMID: 32717561 DOI: 10.1016/j.clineuro.2020.106096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It has been shown that symptomatic or severe carotid atherosclerosis is closely related to cognitive impairment and brain white matter damage. However, there is still a lack of effective and non-invasive imaging biomarkers to identify early high-risk cerebrovascular diseases. Therefore, the purpose of this study is to explore the integrity of brain white matter and cognitive impairment in patients with asymptomatic carotid plaques by using imaging technology. METHODS All subjects were from a project of Stroke Risk Screening and Prevention and were defined as stroke high-risk patients (with three or more stroke risk factors). Tract-based spatial statistics (TBSS) based on diffusion tensor imaging (DTI) was used to analyze the whole brain white matter abnormalities in 61 patients with carotid artery plaque and in 40 healthy controls. At the same time, the general clinical data between the two groups were compared, such as age, gender, smoking, hypertension and cognitive function scores etc. Furthermore, the plaque group was divided into the have-hyperintensities group and the no-hyperintensities group to compare their microstructure of white matter injuries. RESULTS The cognitive scores of plaque group were significantly lower than that of control group. We found that when plaque group and control group were compared, no white matter fiber tracts with difference was found in FA, MD, AD and RD. However, the decrease of FA and the increase of RD were found in some white matter regions (P < 0.05) when comparing the have-hyperintensities group and the no-hyperintensities group. These white matter regions included anterior thalamic radiation, corticospinal tract, cingulum (cingulate gyrus), forceps minor, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus. What's more, there were significant differences in blood pressure between the two groups. CONCLUSION The cognitive function of patients with early high-risk cerebrovascular diseases (asymptomatic carotid plaques) has a downward trend. TBSS based on DTI can help to find out the actual damage of brain white matter in patients with early carotid plaque, and reflect the early pathological changes from the micro level.
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Affiliation(s)
- Lihui Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanbin Wen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Meng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Diseases, Central South University, Changsha, Huan, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
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7
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Meng D, Hosseini AA, Simpson RJ, Welton T, Dineen RA, Auer DP. Large-scale network dysfunction in vascular cognitive disorder supports connectional diaschisis in advanced arteriosclerosis. Eur J Neurol 2019; 27:352-359. [PMID: 31505084 PMCID: PMC6973074 DOI: 10.1111/ene.14084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The interrelation of cognitive performance, cerebrovascular damage and brain functional connectivity (FC) in advanced arteriosclerosis remains unclear. Our aim was to investigate the associations between FC, white matter damage and cognitive impairment in carotid artery disease. METHODS Seventy-one participants with a recent cerebrovascular event and with written informed consent underwent resting-state functional magnetic resonance imaging and the Addenbrooke's Cognitive Examination - Revised (ACE-R). Network and inter-hemispheric FC metrics were compared between cognitively normal and impaired subjects, and interrelated with cognition. In order to explore the nature of FC changes, their associations with microstructural damage of related white matter tracts and cognitive performance were investigated, followed by mediation analysis. RESULTS Participants with global cognitive impairment showed reduced FC compared to the cognitively intact subjects within the central executive network (CEN), and between hemispheres. Patients with executive dysfunction had decreased CEN FC whilst patients with memory loss demonstrated low FC in both the CEN and the default mode network (DMN). Global performance correlated with connectivity metrics of the CEN hub with DMN nodes, and between hemispheres. Cingulum mean diffusivity (MD) was negatively correlated with ACE-R and CEN-DMN FC. The cingulum MD-cognition association was partially mediated by CEN-DMN FC. CONCLUSIONS Long-range functional disconnection of the CEN with DMN nodes is the main feature of cognitive impairment in elderly subjects with symptomatic carotid artery disease. Our findings provide further support for the connectional diaschisis concept of vascular cognitive disorder, and highlight a mediation role of functional disconnection to explain associations between microstructural white matter tract damage and cognitive impairment.
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Affiliation(s)
- D Meng
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - A A Hosseini
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - R J Simpson
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Department of Vascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Welton
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - R A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - D P Auer
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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8
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Lee WJ, Jung KH, Ryu YJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Roh JK. Association of Cardiac Hemodynamic Factors With Severity of White Matter Hyperintensities in Chronic Valvular Heart Disease. JAMA Neurol 2019; 75:80-87. [PMID: 29114731 DOI: 10.1001/jamaneurol.2017.2853] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The cerebral white matter hyperintensity (WMH) is frequently noted in patients with chronic heart disease. Long-term alteration of cardiac hemodynamics might have an influence on the mechanism of cerebral WMH. Objective To investigate the association between chronically altered cardiac hemodynamics and severity of cerebral WMH in patients with chronic valvular heart disease. Design, Setting, and Participants This cross-sectional analysis identified 303 consecutive patients at a tertiary referral center between 2008 and 2016 who were 50 years or older, and diagnosed with severe chronic valvular heart disease and underwent cardiac catherization, echocardiography, and received brain magnetic resonance imaging. Among these patients, 71 with other demonstrated cardiac disease, central nervous system disease, and/or without sufficient catheterization data were excluded, and the remaining 232 patients were included in further analyses. Exposures The site and mechanism of valve diseases, as well as clinical and medication profiles, were reviewed. Cardiac catheterization parameters such as right atrial (RA) mean pressure, right ventricular pressure, and aortic mean pressure were obtained. Comprehensive echocardiographic hemodynamic markers such as left ventricular (LV) ejection fraction, LV mass index, LV end diastolic volume, cardiac index, and E/e' ratio were also obtained. Main Outcomes and Measures White matter hyperintensity volume was quantitatively evaluated using volumetric analysis. Results This study included 232 patients (103 men [44.4%] and 129 women [55.6%]; mean [SD] (range) age, 65.6 [8.8] (51-88) years) in the final analysis. The mean (SD) WMH volume was 5.93 (7.14) mL (median [interquartile range], 4.33 [1.33-8.62] mL), and mean (SD) RA pressure was 10.0 (4.7) mm Hg. From the catheterization data, 147 patients (63.4%) were classified as having a disease involving the mitral valve; 93 (40.1%), aortic valve; 37 (15.9%), tricuspid valve; and 4 (1.7%), pulmonary valve. In multivariate linear regression analysis, adjusting the type and mechanism of valve disease and clinical, echocardiographic, and/or other catheterization parameters, WMH volume was linearly associated with mean RA pressure (B coefficient, 0.702; 95% CI, 0.373-1.031; P = .001), along with age (B coefficient, 0.145; 95% CI, 0.029-0.261; P = .01) and mean aortic pressure (B coefficient, 0.112; 95% CI, 0.034-0.190; P = .005). Conclusions and Relevance Mean RA pressure was independently associated with the WMH volume in chronic valvular heart disease. Chronically altered RA hemodynamics might have a distinct influence on the pathomechanism underlying the development of WMH.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.,Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jae-Kyu Roh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea
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9
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Su JB, Xi SD, Zhou SY, Zhang X, Jiang SH, Xu B, Chen L, Lei Y, Gao C, Gu YX. Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease. Neural Regen Res 2019; 14:858-867. [PMID: 30688272 PMCID: PMC6375028 DOI: 10.4103/1673-5374.249234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Moyamoya disease and cerebrovascular atherosclerotic disease are both chronic ischemic diseases with similar presentations of vascular cognitive impairment. The aim of the present study was to investigate the patterns of microstructural damage associated with vascular cognitive impairment in the two diseases. The study recruited 34 patients with moyamoya disease (age 43.9 ± 9.2 years; 20 men and 14 women, 27 patients with cerebrovascular atherosclerotic disease (age: 44.6 ± 7.6 years; 17 men and 10 women), and 31 normal controls (age 43.6 ± 7.3 years; 18 men and 13 women) from Huashan Hospital of Fudan University in China. Cognitive function was assessed using the Mini-Mental State Examination, long-term delayed recall of Auditory Verbal Learning Test, Trail Making Test Part B, and the Symbol Digit Modalities Test. Single-photon emission-computed tomography was used to examine cerebral perfusion. Voxel-based morphometry and tract-based spatial statistics were performed to identify regions of gray matter atrophy and white matter deterioration in patients and normal controls. The results demonstrated that the severity of cognitive impairment was similar between the two diseases in all tested domains. Patients with moyamoya disease and those with cerebrovascular atherosclerotic disease suffered from disturbed supratentorial hemodynamics. Gray matter atrophy in bilateral middle cingulate cortex and parts of the frontal gyrus was prominent in both diseases, but in general, was more severe and more diffuse in those with moyamoya disease. White matter deterioration was significant for both diseases in the genu and body of corpus callosum, in the anterior and superior corona radiation, and in the posterior thalamic radiation, but in moyamoya disease, it was more diffuse and more severe. Vascular cognitive impairment was associated with regional microstructural damage, with a potential link between, gray and white matter damage. Overall, these results provide insight into the pathophysiological nature of vascular cognitive impairment. This study was approved by the Institutional Review Board in Huashan Hospital, China (approval No. 2014-278). This study was registered with ClinicalTrials.gov on December 2, 2014 with the identifier NCT02305407.
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Affiliation(s)
- Jia-Bin Su
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Si-Da Xi
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Shu-Yi Zhou
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shen-Hong Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Lei
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Xiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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10
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Lee WJ, Jung KH, Ryu YJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Roh JK. Cystatin C, a potential marker for cerebral microvascular compliance, is associated with white-matter hyperintensities progression. PLoS One 2017; 12:e0184999. [PMID: 28910415 PMCID: PMC5599063 DOI: 10.1371/journal.pone.0184999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022] Open
Abstract
Cerebral white matter hyperintensities (WMHs) are central MRI markers of the brain aging process, but the mechanisms for its progression remain unclear. In this study, we aimed to determine whether the baseline serum cystatin C level represented one mechanism underlying WMH progression, and whether it was associated with the long-term progression of cerebral WMH volume in MRI. 166 consecutive individuals who were ≥50 years of age and who underwent initial/follow-up MRI evaluations within an interval of 34–45 months were included. Serum cystatin C level, glomerular-filtration rate (GFR), and other laboratory parameters were measured at their initial evaluation and at the end of follow-up. Cerebrovascular risk factors, medications, and blood-pressure parameters were also reviewed. WMH progression rate was measured by subtracting WMH volume at baseline from that at the follow-up using volumetric analysis, divided by the MRI intervals. At baseline, WMH volume was 9.61±13.17 mL, mean GFR was 77.3±22.8 mL/min, and mean cystatin C level was 0.92±0.52 mg/L. After 37.9±3.4 months, the change in WMH volume was 3.64±6.85 mL, the progression rate of WMH volume was 1.18±2.28 mL/year, the mean ΔGFR was 2.4±7.9 mL/min, and the mean Δcystatin C was 0.03±0.34 mg/L. The progression rate of WMH volume was linearly associated with cystatin C level (B coefficient = 0.856; 95% confidence interval [CI] 0.174−1.538; P = 0.014), along with the baseline WMH volume (B = 0.039; 95% CI 0.019−0.059; P<0.001), after adjusting for the conventional vascular risk factors, laboratory parameters, medication profiles, and GFR. Especially, patients with a baseline level of cystatin C ≥1.00 mg/L exhibited a much higher progression rate of WMH as compared with those with a baseline level of cystatin C <1.00 mg/L (1.60±1.91 mL/year vs. 0.82±1.63 mL/year, P = 0.010). We concluded that serum cystatin C level is independently associated with the long-term progression rate of the cerebral WMH volume. Therefore, serum cystatin C level might predict the progression of cerebral WMH.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
- * E-mail:
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jae-Kyu Roh
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea
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11
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Mishra VR, Zhuang X, Sreenivasan KR, Banks SJ, Yang Z, Bernick C, Cordes D. Multimodal MR Imaging Signatures of Cognitive Impairment in Active Professional Fighters. Radiology 2017; 285:555-567. [PMID: 28741982 DOI: 10.1148/radiol.2017162403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose To investigate whether combining multiple magnetic resonance (MR) imaging modalities such as T1-weighted and diffusion-weighted MR imaging could reveal imaging biomarkers associated with cognition in active professional fighters. Materials and Methods Active professional fighters (n = 297; 24 women and 273 men) were recruited at one center. Sixty-two fighters (six women and 56 men) returned for a follow-up examination. Only men were included in the main analysis of the study. On the basis of computerized testing, fighters were separated into the cognitively impaired and nonimpaired groups on the basis of computerized testing. T1-weighted and diffusion-weighted imaging were performed, and volume and cortical thickness, along with diffusion-derived metrics of 20 major white matter tracts were extracted for every subject. A classifier was designed to identify imaging biomarkers related to cognitive impairment and was tested in the follow-up dataset. Results The classifier allowed identification of seven imaging biomarkers related to cognitive impairment in the cohort of active professional fighters. Areas under the curve of 0.76 and 0.69 were obtained at baseline and at follow-up, respectively, with the optimized classifier. The number of years of fighting had a significant (P = 8.8 × 10-7) negative association with fractional anisotropy of the forceps major (effect size [d] = 0.34) and the inferior longitudinal fasciculus (P = .03; d = 0.17). A significant difference was observed between the impaired and nonimpaired groups in the association of fractional anisotropy in the forceps major with number of fights (P = .03, d = 0.38) and years of fighting (P = 6 × 10-8, d = 0.63). Fractional anisotropy of the inferior longitudinal fasciculus was positively associated with psychomotor speed (P = .04, d = 0.16) in nonimpaired fighters but no association was observed in impaired fighters. Conclusion Without enforcement of any a priori assumptions on the MR imaging-derived measurements and with a multivariate approach, the study revealed a set of seven imaging biomarkers that were associated with cognition in active male professional fighters. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Virendra R Mishra
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Xiaowei Zhuang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Karthik R Sreenivasan
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Sarah J Banks
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Zhengshi Yang
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Charles Bernick
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
| | - Dietmar Cordes
- From the Department of Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV 89106
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12
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Hosseini AA, Meng D, Simpson RJ, Auer DP. Mesiotemporal atrophy and hippocampal diffusivity distinguish amnestic from non-amnestic vascular cognitive impairment. Eur J Neurol 2017; 24:902-911. [PMID: 28547878 PMCID: PMC5518192 DOI: 10.1111/ene.13299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/21/2017] [Indexed: 01/24/2023]
Abstract
Background and purpose The role of clinical factors, cerebral infarcts and hippocampal damage in vascular cognitive impairment (VCI) subtypes remains unclear. Methods Non‐demented patients with carotid stenosis and recent transient ischemic attack/stroke had cognitive assessment and brain magnetic resonance imaging (MRI). Amnestic VCI was defined as memory impairment; non‐amnestic VCI was any other subdomain impairment. Associations of MRI metrics [log‐transformed total ischemic lesion load (log TILL), mesiotemporal atrophy (MTA) score, hippocampal mean diffusivity (hipMD)] with cognitive performance were assessed. Results A hundred and eight patients, 47 with amnestic VCI and 21 with non‐amnestic VCI, were assessed. A higher MTA (odds ratio 12.89, P = 0.001) and left hipMD (odds ratio 4.43, P = 0.003) contributed to amnestic VCI versus normal. Age‐adjusted fluency correlated with log TILL (P = 0.002). Age‐adjusted memory was associated with left hipMD (P = 0.001), MTA (P < 0.001) but not log TILL (P = 0.14). Left hipMD, MTA and smoking showed classification potential between amnestic VCI versus normal (area 0.859, P < 0.001). Conclusions Neuroimaging assists stratification in amnestic VCI characterized by hippocampal changes and in non‐amnestic VCI by higher ischemic burden. MTA and hippocampal diffusivity show diagnostic biomarker potential.
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Affiliation(s)
- A A Hosseini
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Nottingham, UK
| | - D Meng
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Nottingham, UK
| | - R J Simpson
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Nottingham, UK
| | - D P Auer
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Clinical Neuroscience, Radiological Sciences, University of Nottingham, Nottingham, UK
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13
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Lee WJ, Jung KH, Ryu YJ, Lee KJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Roh JK. Progression of Cerebral White Matter Hyperintensities and the Associated Sonographic Index. Radiology 2017; 284:824-833. [PMID: 28394756 DOI: 10.1148/radiol.2017162064] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate the relationship between penetrating arterial pulsation and the progression of white matter hyperintensities (WMHs) by using the sonographic resistance index (RI) along the M1 segment of the middle cerebral artery (MCA). Materials and Methods The study design was approved by the institutional review board of Seoul National University Hospital. The study included 450 individuals who had undergone initial transcranial Doppler (TCD) sonography and magnetic resonance imaging, with follow-up imaging performed within 34-45 months, and who had no stenosis of 30% or more in the internal carotid artery or MCA or a history of stroke other than an old lacunar infarction. MRIR was defined as distal RI divided by proximal RI, where the distance between proximal MI and distal M1 was approximately 20 mm based on TCD evaluation. WMH progression was quantitatively evaluated by subtracting WMH volume at baseline from WMH volume at follow-up. Results At baseline, mean MRIR was 0.974 ± 0.045 (standard deviation), and mean WMH volume was 9.66 mL ± 14.54. After a mean of 38.3 months ± 3.4, the WMH volume change was 4.06 mL ± 7.35. WMH volume change was linearly associated with MRIR (r = 0.328, P < .001), along with the baseline WMH volume (r = 0.433, P < .001) and mean MCA pulsatility index (r = 0.275, P = .037). MRIR values greater than or equal to 1.000 were associated with a greater increase in WMH volume (P < .001). Conclusion MRIR might reflect the pulsation of penetrating arteries and is independently associated with WMH progression. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Woo-Jin Lee
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Keun-Hwa Jung
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Young Jin Ryu
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Keon-Joo Lee
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Jeong-Min Kim
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Soon-Tae Lee
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Kon Chu
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Manho Kim
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Sang Kun Lee
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
| | - Jae-Kyu Roh
- From the Departments of Neurology (W.J.L., K.H.J., K.J.L., S.T.L., K.C., M.K., S.K.L., J.K.R.) and Radiology (Y.J.R.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea (K.H.J., S.T.L., K.C., M.K., S.K.L.); Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea (J.M.K.); and Department of Neurology, the Armed Forces Capital Hospital, Sungnam, South Korea (J.K.R.)
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14
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Hosseini AA, Simpson RJ, Altaf N, Bath PM, MacSweeney ST, Auer DP. Magnetic Resonance Imaging Plaque Hemorrhage for Risk Stratification in Carotid Artery Disease With Moderate Risk Under Current Medical Therapy. Stroke 2017; 48:678-685. [PMID: 28196937 DOI: 10.1161/strokeaha.116.015504] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. METHODS One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. RESULTS Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64-16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1-16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). CONCLUSIONS The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.
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Affiliation(s)
- Akram A Hosseini
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.)
| | - Richard J Simpson
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.)
| | - Nishath Altaf
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.)
| | - Philip M Bath
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.)
| | - Shane T MacSweeney
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.)
| | - Dorothee P Auer
- From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.).
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15
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Haller S, Barkhof F. Interaction of Vascular Damage and Alzheimer Dementia: Focal Damage and Disconnection. Radiology 2017; 282:311-313. [PMID: 28099102 DOI: 10.1148/radiol.2016161564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sven Haller
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology & Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, the Netherlands (F.B.); and Institutes of Neurology and Healthcare Engineering, University College London, London, England (F.B.)
| | - Frederik Barkhof
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology & Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, the Netherlands (F.B.); and Institutes of Neurology and Healthcare Engineering, University College London, London, England (F.B.)
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